In response to the COVID-19 pandemic, there was a rapidly implemented restructuring of UK healthcare services. The The Royal National Orthopaedic Hospital, Stanmore, became a central hub for the provision of trauma services for North Central/East London (NCEL) while providing a musculoskeletal tumour service for the south of England, the Midlands, and Wales and an urgent spinal service for London. This study reviews our paediatric practice over this period in order to share our experience and lessons learned. Our hospital admission pathways are described and the safety of surgical and interventional radiological procedures performed under general anaesthesia (GA) with regards to COVID-19 in a paediatric population are evaluated. All paediatric patients (≤ 16 years) treated in our institution during the six-week peak period of the pandemic were included. Prospective data for all paediatric trauma and urgent elective admissions and retrospective data for all sarcoma admissions were collected. Telephone interviews were conducted with all patients and families to assess COVID-19 related morbidity at 14 days post-discharge.Introduction
Methods
This annotation briefly reviews the history of artificial intelligence and machine learning in health care and orthopaedics, and considers the role it will have in the future, particularly with reference to statistical analyses involving large datasets. Cite this article:
Vascularised fibular grafts (VFGs ) are a valuable
surgical technique in limb salvage after resection of a tumour.
The primary objective of this multicentre study was to assess the
risk factors for failure and complications for using a VFG after
resection of a tumour. The study involved 74 consecutive patients (45 men and 29 women
with mean age of 23 years (1 to 64) from four tertiary centres for
orthopaedic oncology who underwent reconstruction using a VFG after
resection of a tumour between 1996 and 2011. There were 52 primary
and 22 secondary reconstructions. The mean follow-up was 77 months
(10 to 195). In all, 69 patients (93%) had successful limb salvage; all of
these united and 65 (88%) showed hypertrophy of the graft. The mean
time to union differed between those involving the upper (28 weeks;
12 to 96) and lower limbs (44 weeks; 12 to 250). Fracture occurred
in 11 (15%), and nonunion in 14 (19%) patients. In 35 patients (47%) at least one complication arose, with a
greater proportion in lower limb reconstructions, non-bridging osteosynthesis,
and in children. These complications resulted in revision surgery
in 26 patients (35%). VFG is a successful and durable technique for reconstruction
of a defect in bone after resection of a tumour, but is accompanied
by a significant risk of complications, that often require revision
surgery. Union was not markedly influenced by the need for chemo-
or radiotherapy, but should not be expected during chemotherapy.
Therefore, restricted weight-bearing within this period is advocated. Cite this article:
Segmental excision of long-bone sarcomas can require complex reconstruction, often resulting in the use of prosthetic replacements at a young age. The use of vascularised free fibula grafting (VFFG) is well established as a reconstruction modality in sarcoma surgery. To analyse the experience of two European sarcoma centres and their use of vascularised free fibula grafting as a primary and revision procedure in limb salvage for diaphyseal long-bone defects in sarcoma surgery. A retrospective analysis was carried out of 70 consecutive patients undergoing VFFG between 1996 and 2009 under the Oxford Sarcoma Service (Nuffield Orthopaedic Centre) and the Dutch Orthopaedic Tumour Society (Leiden University Hospital). Clinical and radiological assessments were made and functional outcome scores collected.Aims
Methods
Delays to diagnosis and management of soft tissue sarcomas are preventable but still occur. The introduction of a referral proforma to the Thames Valley Cancer Network in 2005 and National guidelines in 2006 aimed to decrease the incidence of partially and inadequately managed soft tissue sarcomas. This study aims to assess referrals for partially or inadequately managed soft tissue sarcomas and their subsequent management. A prospective analysis of all patients referred to the Oxford Sarcoma Service following inadvertent excision of a soft tissue sarcoma between January 2010 and August 2011 was carried out. Pre-operative investigation and subsequent secondary managements were recorded. Patients with a diagnosis of dermatofibrosarcoma protuberans were excluded.Aims
Methods
We reviewed the preoperative radiographs (weightbearing AP) of twenty patients who had scarf and akin Introduction
Method
Between 1997 and 2007, 68 consecutive patients underwent replacement of the proximal humerus for tumour using a fixed-fulcrum massive endoprosthesis. Their mean age was 46 years (7 to 87). Ten patients were lost to follow-up and 16 patients died. The 42 surviving patients were assessed using the Musculoskeletal Tumor Society (MSTS) Score and the Toronto Extremity Salvage Score (TESS) at a mean follow-up of five years and 11 months (one year to ten years and nine months). The mean MSTS score was 72.3% (53.3% to 100%) and the mean TESS was 77.2% (58.6% to 100%). Four of 42 patients received a new constrained humeral liner to reduce the risk of dislocation. This subgroup had a mean MSTS score of 77.7% and a mean TESS of 80.0%. The dislocation rate for the original prosthesis was 25.9; none of the patients with the new liner had a dislocation at a mean of 14.5 months (12 to 18). Endoprosthetic replacement for tumours of the proximal humerus using this prosthesis is a reliable operation yielding good results without the documented problems of unconstrained prostheses. The performance of this prosthesis is expected to improve further with a new constrained humeral liner, which reduces the risk of dislocation.
We retrospectively studied 67 patients who underwent proximal humeral replacement with the Bayley-Walker prosthesis, for tumour of the proximal humerus between 1997 and 2007. Of the 67 patients 10 were lost to follow up. Of the 41 surviving patients, function was assessed using the Musculoskeletal Tumour Society (MSTS) Score and the Toronto Extremity Salvage Score (TESS) questionnaire. 4 of the 41 patients received the new Bayley-Walker ‘captured’ proximal humeral replacement. The mean age was 46 years (7–87). The mean MSTS score at follow-up was 72.0 % and the mean TESS score was 77.2 %. The sub-group of 4 pts who received the new captured prosthesis had a mean MSTS score of 77.7 %. There was no mechanical failure of any prostheses in the follow up period. Endoprosthetic replacement for tumour of the proximal humerus with the Bayley-Walker prosthesis, is a reliable operation yielding reasonable functional results and good long-term prosthesis survivorship. The performance of this prosthesis is expected to improve further with the new ‘captured’ prosthesis.
38 patients (41 knees) who received a primary SMILES knee prosthesis by one of the senior authors between 1990 and 2006 were retrospectively studied. Knee function was assessed pre and post-operatively using the Oxford knee score (0–48 scoring system) and the Knee Society Score. Patients receiving surgery for tumours were excluded. The main indications for primary SMILES were bone loss and ligamentous laxity.
2 patients died and 5 were lost to follow-up. 2 patients required revision surgery (one for infection and one for re-bushing). Post-operative complications included peroneal nerve palsy (1) and DVT (1). The mean Oxford knee score improved from 9 pre-op to 44 post-op, and the mean knee society score improved from 24 pre-op to 71 post-op. The average range of motion was 57 degrees pre-op and 88 degrees post-op.
Chondral damage to the knee is common and, if left untreated, can proceed to degenerative osteoarthritis. In symptomatic patients established methods of management rely on the formation of fibrocartilage which has poor resistance to shear forces. The formation of hyaline or hyaline-like cartilage may be induced by implanting autologous, cultured chondrocytes into the chondral or osteochondral defect. Autologous chondrocyte implantation may be used for full-thickness chondral or osteochondral injuries which are painful and debilitating with the aim of replacing damaged cartilage with hyaline or hyaline-like cartilage, leading to improved function. The intermediate and long-term functional and clinical results are promising. We provide a review of autologous chondrocyte implantation and describe our experience with the technique at our institution with a mean follow-up of 32 months (1 to 9 years). The procedure is shown to offer statistically significant improvement with advantages over other methods of management of chondral defects.